Preventing Skier Knee Injuries – Part 1: Before you get to the hill.

Many of us love winter sports, some even moved here to pursue them. Yet despite our unyielding passion, we all know that the thrill of moving fluidly down a snow covered mountain comes with risks. Among the most dreaded of these is the “blown out” knee.

The knee is a complex joint with many structures, all of which are both subject to injury and needed for sport performance. Knee injuries are common in sports and can be serious enough to end a season or require surgery and months of rehab to optimize recovery.

Given the frequency and potential severity of these injuries, the wise skier seeks to protect their knees to save not just this season, but a lifetime of enjoyment.

Read on to learn more about how to stack the odds in your favor.

Fitness

While one doesn’t need elite level fitness to enjoy a day on the ski hill, skiing faster and steeper runs puts progressively more demands on the body. Even a casual skier requires a certain amount of strength and balance to enjoy the sport. Arriving for a ski vacation having done nothing active in the months before is a for-sure recipe for less fun than you could have had and a possible recipe for an injury. Make the most of your trip or season with an appropriate fitness program incorporating strength and stability. Everyone knows quads are important, but don’t neglect the hamstrings – strength imbalance leads to injury. Keeping your weight close to a healthy range reduces knee wear & tear with every step every day, not just on the ski hill.

Bindings

The binding is a critical link in your safety chain. It transfers the instructions of your body to steer the ski away from danger, and (hopefully) releases before the forces into your body become so great as to cause major damage, but not so easily that you double eject every time you hit a patch of powder.

Binding manufacturers usually recommend having your bindings checked yearly. While we would never say its a good idea to go against the manufacturers’ recommendations, we recognize skiing is not cheap and sometimes choices must be made. That said, if it has been a few years, its time. This is especially true if you have gained or lost weight, or the skiing you are doing has changed significantly. What does this mean? If 4 seasons ago you were hucking cliffs with a maxed out DIN setting and this season you are mostly riding switch on the bunny hill while you teach your kid to ski, it’s be time for less aggro settings. Whether you “still got it” or not, whatever you have will be a lot less if you blow an ACL. Borrowed skis are another mandatory visit with a ski tech. Even if you wear the same boot size, you probably aren’t the same, age, weight, height and ability level. Even if you are, your boots may not interact with the binding the same way. Watch our for excessive sole wear on your boots – this can lead to pre release or failure to release.

Epidemiology research on snownerblades (who knew?) demonstrates non-releasing bindings significantly increase the rate all kinds of lower extremity injury. This includes devastating tibial fractures not usually seen with releasable bindings. Combine that with a beginner skier or an intoxicated expert and its time to call Kenny Loggins, because you have entered the danger zone.

Skis

Select the right ski for you and your skiing. While very fat skis have gained in popularity, we know that progressively more stress is transmitted to the knee with increasing ski width when carving or turning at speed. Conversely, in deep powder, a wider ski can help you float above hidden obstacles and generally move easier.  Research in ski racing has show reduced injury potential at high speeds with a longer radius ski, but if you plan to pick your way between tight trees at a speeds slower than the world-cup, a shorter radius could serve you better. If you are selecting your “one ski quiver” for the season, be realistic and honest with yourself about the type of skiing you do most and the typical conditions in the area you ski.

Knee protection

Knee pads are popular among snowboarders and telemarkers, and can prevent contusions and bursitis in these riders. Some skiers with mild knee arthritis or patellar tracking problems find the warmth, stability and added proprioception of a neoprene knee sleeve to be a benefit. Research from other sports on wearing a knee brace for preventing major injuries has not shown a huge benefit; these types of braces are expensive and some patients find them cumbersome. Unless you have a previously diagnosed ligament injury, a stabilizing knee brace is likely more trouble and expense than its worth.

Helmet

A modern ski helmet is warm, light, comfortable and fashionable. It can also reduce your chances of a serious head injury. Did you know that a helmet could help prevent a knee injury? Concussion research has shown increased rates of ACL and other knee injuries in athletes who had a concussion earlier in the season. Even after concussion symptoms have resolved and it is safe to return to sport, there can be subtle changes in neuromuscular control that place the athlete at greater risk. Save your head and save your knees with a modern helmet from a reputable manufacturer.

Stay tuned for part 2, where we discuss on hill strategies for knee injury prevention.

References

Phys Ther Sport. 2014 Aug;15(3):200-10. Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review.

Am J Sports Med. 2015 Aug;43(8):2049-56.Anterior Cruciate Ligament and Knee Injury Prevention Programs for Soccer Players: A Systematic Review and Meta-analysis.

PLoS One. 2015 Dec 4;10(12):e0144063. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis.

J Sport Rehabil. 2012 Nov;21(4):371-7.The effectiveness of injury-prevention programs in reducing the incidence of anterior cruciate ligament sprains in adolescent athletes.

Br J Sports Med. 2016 Jan;50(1):20-5. Effect of ski geometry on aggressive ski behaviour and visual aesthetics: equipment designed to reduce risk of severe traumatic knee injuries in alpine giant slalom ski racing.

J Sports Sci Med. 2015 Aug 11;14(3):606-19. The Waist Width of Skis Influences the Kinematics of the Knee Joint in Alpine Skiing.

Sports Health. 2016 Nov/Dec;8(6):561-567. Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes.

Sports Med. 2017 Apr;47(4):599-614 How to Prevent Injuries in Alpine Ski Racing: What Do We Know and Where Do We Go from Here?

Br J Sports Med. 2003;37:511–515 Snowblading injuries in Eastern Canada

Br J Sports Med. 2016 Jan;50(1):37-40. doi: 10.1136/bjsports-2015-095482. Factors associated with self-reported failure of binding release among ACL injured male and female recreational skiers: a catalyst to change ISO binding standards?

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